Clinical Use of New Brain-Scanning Technology

Dr. David Okonkwo is using a new and superior form of MRI—a scan that would help a neurosurgeon understand how a brain bruise might affect neurological connections and affect a patient’s life.

McGowan Institute for Regenerative Medicine affiliated faculty member David Okonkwo, MD, PhD (pictured), assistant professor of neurological surgery and director of neurotrauma, director of spinal deformity at UPMC Presbyterian, and clinical director of the Brain Trauma Research Center of the University of Pittsburgh, has partnered with Walter Schneider, a University of Pittsburgh psychology professor and senior scientist at Pitt’s Learning Research and Development Center, to better understand the workings of the human brain. Dr. Schneider and his colleagues are developing a brain-scanning technology that may allow doctors to determine not only where brain injuries are, but also how the injuries will influence a patient’s ability to speak, walk, and think. Dr. Okonkwo is using this new and superior form of MRI—a scan that would help a neurosurgeon understand how a brain bruise might affect neurological connections and affect a patient’s life.

Matt Stroud, a staff writer for Pittsburgh Quarterly, recently reported on Dr. Schneider’s technology: High Definition Fiber Tracking, which makes the brain’s connections visible. Instead of a flat, black and white MRI image, the new technology shows a three-dimensional image of the brain filled with what looks like thin, multi-colored strands of spaghetti. These strands, however, are more like fiber optic cables than food. And they can be mapped to show doctors which brain connections are functional and which aren’t.

Dr. Schneider believes the technology can help revitalize surgical planning and operating room guidance. “If you know where the cables are going, how they connect, and what function they serve, you’re less likely to cut something that’s going to cause irreparable damage.” He also believes High Density Fiber Tracking will change the way doctors treat genetic brain disorders such as autism, as well as traumatic brain injuries.

“It really does present tremendous opportunities,” Dr. Schneider said. With Dr. Okonkwo’s help, Dr. Schneider and his team typically look into two clinical cases per week—one in neurosurgery, one in traumatic brain injury. Cases are chosen on the basis of their complexity and whether UPMC neurosurgeons are having trouble with diagnosis or surgery.

Recently, Dr. Okonkwo secured funds and permission to run a High Density Fiber Tracking scan on a patient’s brain. It was not a fairy tale ending. The scan showed that about 54 percent of the connections in the patient’s brain influencing movement of his left leg were severed and likely dead. At best, in other words, he would have to make do with about half the strength of his left leg prior to his injury. The scan showed that about 97 percent of the connections influencing movement of his left arm were severed and likely dead. At best, his arm would operate at about 3 percent strength; in other words, it would be largely immobile for the rest of his life.

“Is he happy with his situation? No,” Dr. Okonkwo said. “It’s wonderful that he’s recovered as much as he has. But, when you’re well, you just assume you’re going to be well every day of your life. We take that stuff for granted. So there’s still frustration associated with the things he can’t do and the functional limitations he has. But at least now he some idea about what he can expect.”

“Now, rather than spending most of his days being angry about not knowing, he understands what he has to work with and how he can deal with it. The hardest part really is the unknown. And anything we can do to minimize that is a victory for everyone.”

Illustration: University of Pittsburgh, Department of Neurological Surgery.